Dr. Kara Fitzgerald & Dr. Stephen Sinatra

In the past 40 years, the practice of cardiology has changed significantly and Dr. Stephen Sinatra has been at the forefront of that change. He introduced the concept of metabolic cardiology, pioneered the use of COQ10 in reversing previously untreatable cardiac conditions, and was among the first to recognize the healing power of food when it comes to heart health. In this episode of New Frontiers, Dr. Fitzgerald talks with Dr. Sinatra about how he came to functional medicine so early in his career, how he uses supplements and nutrition in his cardiology practice (including his view on saturated fats), and what supplements he personally takes every day.

In this podcast, you’ll hear:

How Dr. Sinatra’s training as a psychotherapist improved the outcomes he gets as a cardiologist

How he uses coenzyme Q10 to treat specific conditions and his dosing recommendations

About the importance of stem cell renewal in metabolic cardiology

Why magnesium and potassium are critical for heart health

Why most people are deficient in magnesium and could benefit from supplements

Why he puts any patient with a history of coronary heart disease on vitamin K2

About the lesser known supplement that he considers absolutely essential for heart health

How to eat for optimal cardiac health and what specific foods to include and avoid

Why listening to your patients is the best way to become a better doctor

Dr. Kara Fitzgerald:Hi everybody, welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine and of course today is no exception.

I’m thrilled to be here with a fellow Connecticut resident, Dr. Stephen Sinatra. Let me tell you a little bit about him. I’m sure you already are well versed in who he is and what he does but his background, he’s a board-certified Cardiologist and he’s an Assistant Clinical Professor of Medicine at University of Connecticut School of Medicine in Farmington, Connecticut. He’s certified as a bio-energetic psychotherapist and nutrition and anti-aging specialist. Dr. Sinatra integrates psychological, nutraceutical, and electroceutical therapies into the matrix of healing.

He’s the founder of heartMDinstitute.com, an informational website dedicated to promoting public awareness of integrative medicine, as well as vervana.com and we’ll provide those links in the show notes. That’s a website focused on high vibrational living and foods. He’s been formulating supplements with Healthy Directions for 25 years. He’s a fellow in the American College of Cardiology and the American College of Nutrition.

I also want to add that he’s published many, many, many peer-reviewed articles. He’s contributed chapters to many integrative cardiology textbooks and he has generated lots of superb content for the nonprofessional audience as well.

Dr. Sinatra, it’s an honor to be with you. You’re a real founding father of our field. Welcome to New Frontiers.

Dr. Stephen Sinatra:Well, thanks so much for that very kind introduction. That was really nice of you.

Dr. Kara Fitzgerald:I want to tell you a little background. Now we have a ton of, as you and I were just talking about, I have loads of questions. Since I’ve got you on the line, I want to pick your brain thoroughly, but I just wanted to share with you a cute anecdotal story from my history and yours as well.

When you were a cardiology fellow at Saint Francis, my mom was a cardiac nurse working with you, Noelle Manning.

Dr. Stephen Sinatra:Oh wow, okay.

Dr. Kara Fitzgerald:She actually helped you set up your first office.

Dr. Stephen Sinatra:Really?

Dr. Kara Fitzgerald:Yes.

Dr. Stephen Sinatra:You mean with Dr. Landry in Hartford or…?

Dr. Kara Fitzgerald:Was it Liss, Dr. Liss?

Dr. Stephen Sinatra:Oh, well Liss was one of the attendant cardiologists at Saint Francis and then I want into practice with Dr. Landry since I was […] his office I was getting and he felt a little bit compromised and he said, “Why don’t we go and practice together,” and that’s how it all started.

Dr. Stephen Sinatra:It was opened 50 years ago. Well maybe 47 years ago.

Dr. Kara Fitzgerald:That was my mom and she used to bring us to the exercise physiology lab, every once in a while we would end up there, I don’t know why, and it was so much fun. We would jog around the lab. Anyway, maybe our paths crossed when I was a little one.

Dr. Stephen Sinatra:That’s really sweet.

Dr. Kara Fitzgerald:Isn’t that cute?

Dr. Stephen Sinatra:It is.

Dr. Kara Fitzgerald:She was excited, she was actually really excited to hear that I was talking to you today.

Let’s jump in, we’ve got loads to talk about and you’ve just been in the trenches here. Actually, you know what? Let me just ask you, me having met you when I was a youngin’ and you were doing your fellowship, when did you transition into integrative medicine? When did you really start thinking about it?

Dr. Stephen Sinatra:It’s an amazing story. I had just taken my cardiovascular boards. I passed the internal medicine boards right out of my residency and took the cardiovascular boards. I was only 31 years old as a board certified cardiologist. I took them at Yale and I’ll never forget this, I had a patient come in from Ohio who lived part-time in Connecticut. He had some really severe refractory high blood pressure and he asked me if I would speak to a Dr. Jacob Rinse, a chemist from Holland, because he knew him from the petroleum industry.

I said, “Sure, I’ll be happy to talk to him.” I spoke to this PhD Dr. Rinse and he was 91 years old and he absolutely changed my life.

Dr. Kara Fitzgerald:Wow.

Dr. Stephen Sinatra:When I was on the telephone with him, it was absolutely incredible. He was erudite, he was funny, he was sharp, he had no symptoms of Alzheimer’s disease and then he said to me, “I reversed my own atherosclerosis.” I said, “What? You mean you reversed plaque?” He goes, “Yes.” I go, “How’d you do that?” He was talking about omega-3s, vitamin E, magnesium, phosphatidylserine, phosphatidylcholine. I didn’t even know what he was talking about back then.

When I got off the phone I said to myself, “Well maybe that was set up by the angels or something. Maybe I was supposed to hear this conversation.” Ever since that conversation I became a conventional cardiologist in recovery so to speak.

Dr. Kara Fitzgerald:Wow, so…

Dr. Stephen Sinatra:He changed my life. I was so young. I started to get involved with nutrition and food and vitamins and minerals. Then I went to a Gestalt psychotherapy training program. I studied with a lot of Fritz Perl, psychotherapists from the West Coast. Then on a reading list I read a book by Alexander Lowen called “Bioenergetics” and I thought this would be a perfect fit for me as a heart specialist. Then I did a 10 year training program in bioenergetics and became a psychotherapist. Then when I was in training for psychotherapy I realized that I was deficient in nutrition, so I took the board examination given by the American Board of Nutrition and I passed that. Around that time I was working with the A4M and I took the anti-aging boards. That’s how my process evolved. I just starting taking more and more training in addition to my training in contemporary cardiology. I just branched out into other areas. I’m still going to conferences. It’s amazing, I go to conferences to lecture, but lots of times I go to conferences just to learn as well, just like you do. It’s a great ride for me and I’m always learning, which is really, really special.

Dr. Stephen Sinatra:Yeah. Throughout my career I’ve written about 24 books, either coauthored or authored and published dozens of articles in the contemporary medical literature and various journals and I’m still doing it. It’s been really fun.

I’ll tell you this, Kara, I have learned so much in the last … since I left my practice when my son was sick I stopped my practice because I had to deal with that. I have to tell you, over the last 10 years I’ve even learned even more than I thought I learned in the last 30 years. It’s been an incredible ride and it still continues. It still continues and I absolutely love what I do.

The worst thing about becoming a doctor like you and I? it takes decades to really learn what we’re doing. Then all of a sudden we’re too old and then we die. You gather all this information, experience, and knowledge that you want to share, but then all of a sudden you’re coming to the end of your lifetime.

For me, medicine has been an incredible journey and it still continues.

Dr. Kara Fitzgerald:Yes, and the research is just exploding as we move into systems medicine and the genome has been mapped. Now we’re looking at all sorts of different -omics and metabolomics. It’s an exciting time to be in medicine and in science.

Dr. Stephen Sinatra:I think it’s going to be easier for you as a clinician with the BioGenome Project being deciphered.

Remember differential diagnosis that you learned in medical school?

Dr. Kara Fitzgerald:Yeah, mm-hmm (affirmative).

Dr. Stephen Sinatra:Well, now you’re going to go right to the BioGenome, figure out what pathways patients have or where their genetic weakness lies and you’ll be able to plug them up with various therapies. I think medicine is going to be a lot easier in the future.

Dr. Kara Fitzgerald:That’s pretty interesting. That’s a really interesting prediction. It’s like we’re at the equivalent of the Industrial Revolution at the turn of the last century.

Dr. Stephen Sinatra:Exactly. Look at all the SNP’s people have and with just the genetic deficiencies, whether it’s MTHFR, or the alleles, the APOE4 alleles. There are so many different genetic SNP’s going on and sulfate pathways. Like I said the MTHFR, the folate pathways, the methyl pathways, it’s so complicated, but yet, with the BioGenome project I think the newer doctors are going to study this and be able to really hone in on the person’s problem right away, right away.

Dr. Kara Fitzgerald:We are at an extraordinary and very powerful turning point in truly individualized medicine.

All right, I’ve got one more super quick question and then I know people are going to kill me if we don’t dive into the meat of this. I’m just curious, since you transitioned into integrative cardiology early on how did your fellow conventional cardiologists receive you? We’re in Connecticut, we’re extremely conservative.

Dr. Stephen Sinatra:It was a tough ride for me, especially when I was Chief of Cardiology at Manchester Memorial Hospital. Even though I was publishing a lot of papers and writing a lot of books when I was speaking on coenzyme Q10, or if I was talking about folate, or Vitamin B12 deficiencies, and homocysteine, doctors were walking out of the room. I was even the Director of Medical Education. Sometimes it was a lonely ride because I felt like I was a salmon swimming upstream, so to speak. I didn’t want to convince people, but I thought I was given some gifts early on.

My discovery of coenzyme Q10, back in 1982 when I first dealt with a woman with, it was amazing, Kara, she had postpartum cardiomyopathy. I’ve only seen a few cases in my entire lifetime. She was in florid pulmonary edema and heart failure. She went from doctor to doctor, was waiting for a heart transplant. She was only 29 years old. She had a two-year-old and a little infant child of only a few weeks old. She came to see me. It was amazing. I put her on coenzyme Q10, only 10 milligrams 3 times a day, and after a few days she was able to sleep through the night without coughing. After a week she was able to walk across the room. Then after two weeks she felt so good. Then they found a heart for her three or four months later. She calls me up, she goes, “I feel fine. Do I really need this heart?” I said, “It’s your choice.” Now she’s 73 years old. So it’s amazing. That was the first incredible case I ever saw with a COQ10 reversal of cardiomyopathy. Since that time, oh my gosh, I’ve had dozens and dozens of patients who were taken off heart transplant lists.

Dr. Kara Fitzgerald:That’s extraordinary.

Dr. Stephen Sinatra:Just with coenzyme Q10…

Dr. Kara Fitzgerald:Yeah, but wait…

Dr. Stephen Sinatra:… but when metabolic cardiology came around, oh my God, it was even better.

Dr. Stephen Sinatra:10. I started her on 10, 3 times a day. You got to realize when people are very deficient in coenzyme Q10, especially in a postpartum cardiomyopathy, when the infant or the fetus gets it all, remember that, they just suck the mother dry, even minimal COQ10, and back then we didn’t know about it. I was using low doses, but now I use 100 milligrams, 3 times a day.

Dr. Kara Fitzgerald:Right, right, and some studies go up to 1000 or more. There’s a Parkinson’s study out there I think using…

Dr. Stephen Sinatra:Oh, yeah…

Dr. Kara Fitzgerald:… three grams.

Dr. Stephen Sinatra:… the Parkinson’s study and then even in the Huntington’s Career Study they were using two grams or more per day of coenzyme Q10. The thing about coenzyme Q10 is you can take massive doses.

Remember this, Kara, a body makes COQ10 and a body makes ribose, and the body makes carnitine. So any of those ingredients since the body makes it you can go higher up on the scale because it’s very natural for the body. The body doesn’t see it as an allergic protein, so to speak.

Dr. Kara Fitzgerald:Yes, right. She was obviously absorbing it sufficiently. No one would give 10 milligrams TID. It’s an incredible story. Thank you so much for that pearl.

Then the fact that you turned around so many people, then they did not require a heart transplant is just amazing.

Listen, I was going to ask you about metabolic cardiology later, but talk about it right now. You coined the term. What is it? Let’s just jump into it because it’s…

Dr. Stephen Sinatra:Sure.

Dr. Kara Fitzgerald:… just a fitting transition.

Dr. Stephen Sinatra:Most of us remember from high school biology ATP, we call it the adenosine triphosphate. ATP is really the energy of life. Even the German war criminals during World War II knew that if they took cyanide they could commit suicide within seconds because we only have ATP for eight seconds. We have to keep making it through the Krebs cycle. In other words, we turn over metabolic pathways 1000s of times per millisecond. The German war criminals knew this so they would use cyanide as a quick way to end their life.

It’s amazing if you drive ATP in a preferential direction and you use supplements that help to build ATP, the coenzyme Q10 and carnitine will increase the turnover of ATP while ribose is the center of the ATP molecule. In other words, ribose is a five-sided sugar. When you take the ribose now you’re giving a substrate for ATP and you’re using coenzyme Q10 and carnitine and the same time, now you’re driving ATP.

I’ve got to tell you this, Kara, with the advent of stem cells and what we’ve learned in the last, oh gosh, even 10 years, I can remember reading a journal article, it was in 2009, it was in the Science journal. I had this incredible excitement and joy because I believe, I believe that metabolic cardiology is connecting with the wisdom of the stem cells of our body because our body wants to heal itself. It really wants to heal itself no matter whatever we do. Basically, if you can connect the dots and drive the metabolic machinery into the next step, which is stem cell renewal or revival, that’s where I think metabolic cardiology is working.

There was another article that came out by the same group of researchers in 2017 which showed that our stem cells can even regenerate a damaged heart over a period of let’s say 40 years. If I had a patient with a massive heart attack and let’s say had pump function or rejection fractures of 10-15%, if I gave that patient metabolic cardiology and they lived another 5 or 10 years, now their own intrinsic stem cells would take over and replace their damaged heart cells with new heart cells. That’s the excitement of this whole stem-cell technology. Now, we’ve only learned within the last I would say decade. I would say metabolic cardiology is really the greatest discovery I ever made in my lifetime.

Dr. Kara Fitzgerald:That’s extraordinary. I know the workhorse nutrients for you. You’ve just mentioned carnitine, COQ, and ribose. Of course the other pillar is magnesium.

Dr. Stephen Sinatra:Correct.

Dr. Kara Fitzgerald:Magnesium, I just want to tell you, magnesium of course, harnesses those phosphates in ATP. I remember reading a little … I read this estimate that we cycle through like kilograms of magnesium. Obviously, we reuse it time and time again as we spin through ATP synthesis. Talk about magnesium and what you think about it.

Dr. Stephen Sinatra:When Jacob Rinse, when I had that phone call when I was only 31 years old, he was a magnesium addict at that point he told me. He started me off on magnesium early. Then when I researched it, as a board certified cardiologist we’d occasionally run into these refractory cardiac arrhythmias, they’re horrible. They’re called Torsades de pointes where you get a swing in ventricular tachycardia. One of the only things that would correct that is IV magnesium. Here I was a board-certified cardiology talking to Rinse on the telephone, learning about magnesium.

You know, Kara, when I was in my early 30s I was treating ventricular arrhythmias in the CCU and the ICU using magnesium drips in combination with anti-arrhythmic medications. I was using magnesium very early on in my career because it would stabilize the heart and it would lower blood pressure. Now we know it protects the endothelial cells from endothelial cell dysfunction, so it’s really important in atherosclerosis. The problem is that our soils are so depleted with magnesium that if people don’t take magnesium as a supplement … By the way, I take magnesium every night. When I brush my teeth I use 200 or 300 milligrams of magnesium as a chaser when I swallow my water. Magnesium, I think is one of the most important minerals in our body and unfortunately it’s really deficient in our diet, so we need to take it as a supplement.

Dr. Kara Fitzgerald:Do you like a form of magnesium?

Dr. Stephen Sinatra:That’s a good question. When I was at a COQ10 conference about 12-13 years ago the Australians were talking magnesium orotate. It’s the only form of magnesium that drives ATP in a preferential direction. So when I was working at Healthy Directions, and I’d make my own vitamin and mineral formulas, I’ve been doing it for over 30 years, I was the first American to come out with a magnesium preparation that uses magnesium orotate. The magnesium formula that I use on drsinatra.com is a combination of magnesium orotate, citrate, glycinate, and malate. I use different Krebs cycle components of magnesium and they’re very, very good, I have to tell you. Magnesium is a vital mineral that we really need in our body, so we need the Krebs cycle components so it’s utilized in the body.

Dr. Kara Fitzgerald:What about good old potassium, I mean…

Dr. Stephen Sinatra:Very important. For a cardiologist like myself I would have people eating high potassium foods. A lot of seaweeds are very high in potassium. I like bananas, but the only problem with bananas is it’s pure carbohydrates, so I’m starting to get away from that. There’s loads of potassium in potatoes. Again, potatoes are a high carbohydrate, but you can get potassium in fresh fruits and vegetables with low glycemic indexes so you’re not flooding the body with all that sugar. I’m a big believer in potassium and magnesium in being vital minerals for the cardiovascular system.

Dr. Kara Fitzgerald:Listen, not that long ago we started using ubiquinol for COQ10, or some of us did. The original work was on ubiquinone and that’s what you were turning around heart failure patients with. Have you thought about using the reduced form, ubiquinol, these days or have you experimented with it, or do you still?

Dr. Stephen Sinatra:Oh yeah. Look I use…

Dr. Kara Fitzgerald:What do you think?

Dr. Stephen Sinatra:I’ve been using COQ10 for, oh gosh, let’s see, since the early 80s. I’ve been using COQ10 for more than 30 years.

Dr. Kara Fitzgerald:Decades.

Dr. Stephen Sinatra:I do all forms of ubiquinone. When Kaneka came out with ubiquinol I used that form as well. I even did my own independent research. I did blood studies on … In other words, if you have a highly bioavailable form of ubiquinol, which I’ve used with Raj Chopra — by the way, we’re all going to the COQ10 conference, which is going to be in New York City this weekend — so this will come up again. I can tell you the patent for ubiquinol is coming off. I can tell you this Kara with 100% certainty that a good quality ubiquinone is equally as good, if not better, than a good quality ubiquinol.

The problem with ubiquinol is that some people, and I did the independent research, and then somebody wrote in on a Townsend Letter, I don’t know if you read the Townsend Letter, but a long distance runner when he switched over to ubiquinol had poorer times. In other words, he could not run as fast on ubiquinol as opposed to ubiquinone.

Dr. Kara Fitzgerald:Isn’t that interesting?

Dr. Stephen Sinatra:Then I had a world renowned weight lifter, a female here in Connecticut who when I did my independent study she could not tolerate ubiquinol because she had fatigue. She was begging me to come off it. I don’t know why ubiquinol in the adult population would have these minimal side effects, for in some people are major. I will tell you this, I think the only advantage ubiquinol has over ubiquinone is in very, very young children with inborn errors of metabolism where they had such genetic deficiencies, like maybe a Friedreich’s ataxia or something like that, where they need a more highly active form of COQ10. I think in that population ubiquinol might have an advantage. But the adult population, no, I am not convinced. Why should people spend more money on COQ10 when you really don’t have to?

Dr. Kara Fitzgerald:Right.

Dr. Stephen Sinatra:My patients, like you said before, I use hundreds of milligrams. You use ubiquinol at hundreds of milligrams, this is going to be expensive for a lot of these patients. I rely on a good quality highly bioavailable form. What bioavailable means is that you’re absorbing it into the tissues of the body and that’s the magic of coenzyme Q10.

Dr. Kara Fitzgerald:I think your experience speaks to it. Of course, the majority of data is on ubiquinone.

All right, listen, I’m going to ask you since we’re on this…

Dr. Stephen Sinatra:By the way, the patents are coming off, like I said before, ubiquinol. They’re going to be totally equal. In fact, I wrote a whole monograph to the COQ10 Association and I’m sure they’re going to discuss part of that at the conference next weekend in New York City.

Dr. Kara Fitzgerald:Well, it will be interesting to see though because some of these stories you’re sharing are pretty compelling. I experimented with ubiquinol, but you’re right, it’s cost prohibitive and the research is on ubiquinone. It will be interesting to see when the price point is more reasonable, just outcomes with it.

Dr. Stephen Sinatra:Of course.

Dr. Kara Fitzgerald:But you’re not convincing me to switch given what you’ve just said.

All right, listen, I want to ask you one other question in the supplement arena and then I want to move into nutrition.

Clotting and K2, clotting and K2, give me…

Dr. Stephen Sinatra:Oh my favorite.

Dr. Kara Fitzgerald:Yeah, okay, go for it. Let’s talk.

Dr. Stephen Sinatra:About 13 or 14 years ago I met Cees Vermeer and Dr. Leon Schurgers at Yale New Haven. One of them was there lecturing on some aspect of Vitamin K and I had dinner with them because it was amazing. Here I am a board-certified cardiologist, I didn’t know anything about Vitamin K2. Leon Schurgers spent 30 years of his life studying Vitamin K2.

Now what is K2? Well K2 is a … First of all, there are two forms of Vitamin K. There’s K1 that’s involved with clotting. So if a person let’s say is on pro time, if a person’s, let’s say, blood is too thin, taking coumadin for example and their pro time levels are very elevated you have to be careful and you have to give Vitamin K1. We’ve all had that experience of a person being on an anti-coagulant, they had to go to surgery, and we have to reverse quickly.

Vitamin K2 is different. Vitamin K2 literally takes out calcium out of, let’s say, blood vessels where it doesn’t belong and then puts it back in bones where it does belong. Menaquinone-7 is a very bioavailable form of Vitamin K2, much more bioavailable than MK-4, for example, that’s sold in lots of different vitamin formulas. It really doesn’t work as well as MK7.

When I met Schurgers and Cees Vermeer these two Dutch scientists, it was like meeting the Dutch chemist years ago all over again. We had this incredible aha. I said, “This is the greatest stuff I’ve ever came across.” They presented their Rotterdam study, which showed that people would have aortic aneurysms. People in Holland were eating cheeses that contained Vitamin K2. They literally strengthened their blood vessels. It was absolutely amazing.

Ever since I met these two scientists, I actually brought Vitamin K2 to Healthy Directions. Since I met them I take 300 micrograms of Vitamin K2 every day. I had two EBCT scans, by the way, Kara, which is black in coronary vessels, and my last scan I was zero again. I just feel that … By the way, I have a family history of cardiovascular disease. I lost my dad when he was 74 of an acute Type I dissection of the aorta. At postmortem he was riddled with atherosclerosis. For me, taking Vitamin K2 is a lifesaver in the fact that my scans have not shown calcification of blood vessels. That’s the miracle of Vitamin K2. It’s one of those must-have supplements.

Anybody with a family of coronary disease I put people on Vitamin K2. I put people on Vitamin K2 if they have a handful of risk factors for sure. If anybody wants to take K2 I would not discourage them at all because, as you know, for both men and women, especially women, coronary artery disease is the leading cause of death in women. Vitamin K2 is a very important nutrient. Not only will it help to prevent heart attack in women, but the most feared disease in most women today is osteoporosis and now Vitamin K2 is going to strengthen the bones in women. I just feel it’s one of those magical nutrients for all women and most men.

Dr. Kara Fitzgerald:… are you changing that when you’re working with somebody with atherosclerosis or you’re thinking about bone density? Is that what you think is the sweet spot for…

Dr. Stephen Sinatra:That’s the sweet spot. I was on the phone with Mark Houston the other day and he takes 500 micrograms.

Dr. Kara Fitzgerald:That’s close.

Dr. Stephen Sinatra:That’s a big dose. 300 … The Dutch researchers commented on 300 as well. By the way, I would be happy if somebody took 150 of Vitamin K2, as long as it’s MK-7, it has to be menaquinone-7. If it’s menaquinone-4, unfortunately a lot of people use menaquinone-4, it’s like the ubiquinol, ubiquinone situation all over again. I just feel if they take MK-7, if they take 150-180 mics I would be happy with that.

Dr. Kara Fitzgerald:They’re good, they’re good. You know what, it was MK-4 I think that really got the original research attention certainly looking at bone health. I think it’s very conclusive at this point that MK-7 is superior.

Dr. Stephen Sinatra:Oh, far superior bioavailability. It lasts in the body so much longer, oh my gosh, it’s like night and day.

Dr. Kara Fitzgerald:Listen, one more supplement question, open up your supplement closet, no just tell me…

Dr. Stephen Sinatra:Okay, go ahead.

Dr. Kara Fitzgerald:What is your maintenance protocol?

Dr. Stephen Sinatra:My maintenance?

Dr. Kara Fitzgerald:Yeah.

Dr. Stephen Sinatra:You mean what do I take?

Dr. Kara Fitzgerald:Yeah, what do you take? What are you taking today?

Dr. Stephen Sinatra:You sure you want me to tell you what I take?

Dr. Kara Fitzgerald:Well…

Dr. Stephen Sinatra:I take a lot of stuff. All right…

Dr. Kara Fitzgerald:Give me your…

Dr. Stephen Sinatra:Let me say this then. I take magnesium every night. I take coenzyme Q10 every day. I take omega-3s. I take a little bit of carnitine, about 500 milligrams a day. I take resveratrol and turmeric because those are in my own supplements of Healthy Directions. I put resveratrol, turmeric, COQ10, I’ll make it three together.

Now, one supplement, I was in Japan about 12 years ago and I learned about astaxanthin. Are you familiar with…

Dr. Kara Fitzgerald:Yes.

Dr. Stephen Sinatra:… astaxanthin?

Dr. Kara Fitzgerald:Yep, absolutely.

Dr. Stephen Sinatra:I started using that as soon as I was in Japan when I learned about it. This is one supplement that I think really glitters. This is a carotenoid that is just awesome. It comes from seaweeds. It also has a lot of polyphenol activity in it. It is an amazing substance because not only does it support the brain and the heart, two of the vital organs, but it’s great for skin, especially for skin for women who want a nice complexion, and it’s great for the retina of the eye. I take 12 milligrams of astaxanthin a day. Again, it comes from seaweed, so I just feel it’s one nutrient that everybody should take, in addition to COQ10, omega-3, a good multi, and stuff like that.

Dr. Kara Fitzgerald:Yeah, okay, good. I think we can access some of that information on your generally recommended protocols, and folks, we’ll put it in the show notes along with links. We’ll definitely grab as many of the citations that Dr. Sinatra is mentioning here and do our best to just populate the show notes.

Incidentally, you’ve got that really nice article you published earlier this year with Mark Houston, Deanna Minich, Joel Kahn.

Dr. Stephen Sinatra:Oh yeah.

Dr. Kara Fitzgerald:“Recent Science and Clinical Application of Nutrition to Coronary Heart Disease”, this is the Journal of American College of Nutrition, January 2018. It’s a free full text, so we’ll put a link on that or we’ll just put the PDF on the show notes. Really nice review article.

Dr. Stephen Sinatra:Even though I was the third author on that, Kara, I really worked hard on that article. I have to tell you, Mark killed himself on it. The bibliography in itself was very, very painful. I have to be honest with you, it was a tough article and I’ve published a lot of articles.

Dr. Kara Fitzgerald:It’s dense. It’s dense, there’s no doubt.

Dr. Stephen Sinatra:It is, it is.

Dr. Kara Fitzgerald:It’s a great paper though, it is.

Dr. Stephen Sinatra:I was arguing with my authors because some of the authors didn’t agree with coconut oil and some of us agreed. We had a little dissension among ourselves.

Dr. Kara Fitzgerald:All right let’s talk…

Dr. Stephen Sinatra:We just went positive neutral on coconut oil.

Dr. Kara Fitzgerald:All right, that’s awesome. We’re going to get to coconut oil. We’re going to talk about saturated fats here in a minute, I hope. We’ve got so much to cover. Let’s do a part two.

Anyway, I want to talk about nutrition. The PREDIMED study, that 2013 New England Journal of Medicine where they put the Mediterranean diet to the test and they had some pretty amazing outcomes. Actually, there was a lot of olive oil used in one of the study arms. Talk about this study and just give me the big picture snapshot, and what you’re thinking about.

Dr. Stephen Sinatra:Okay, all right, well with a last name like Sinatra I have some Italian, actually my grandfather came from Sicily and…

Dr. Kara Fitzgerald:Well, New York Italian. I can hear New York Italian.

Dr. Stephen Sinatra:I know, New York, New York. But I have to tell you, I grew up on olive oil. Thank God my grandfather put me on olive oil as a young child. I developed a taste for olive oil very early on. Then if you look at the oldest populations in the world, the Mediterranean Basin as well as the Okinawans, the southern tip of Japan, they’re very close. They’re only a couple of months apart, but the average age of a Mediterranean in the Mediterranean Basin is around 84.7, in Okinawa is a little higher, closer to 85, 6 years ahead of the average American so to speak.

I believe that olive oil is the secret sauce of the Mediterranean diet, there’s no question. Several years ago there was an article that came out that blew me away. It was another article that gave me this incredible aha that I had this glow in my body, so to speak, after reading it where researchers demonstrated that olive oil could reduce inflammatory gene expression.

Think about that, Kara, we all have inflammatory genes. We’ve learned this again in the BioGenome project that got released when three guys won the Nobel Prize back in 1993. It’s still relatively new. Now that we know that olive oil, extra virgin olive oil, can reverse inflammation in the body. When the researchers at the PREDIMED study were given one set of participants four tablespoons a day, of extra virgin olive oil versus the American Heart Association diet … Again, nuts, remember the studies in the Seventh Day Adventists who are vegetarians who eat a lot of nuts. A lot of nuts contain a lot of good nutrients and monounsaturated fats where you don’t need much insulin to metabolize the fats, that’s why fats are good for you, if you don’t get the inflammatory response of insulin. The Seventh Day Adventists who ate nuts and the same people in the PREDIMED study who ate a lot of nuts, that class and the olive oil class had less heart attack, less stroke, less hypertension, less Alzheimer’s disease. It was absolutely amazing.

When I read the study, and we needed speakers for the American College of Nutrition, and I’m on the board of directors, about three or four years ago, I invited Dr. Gonzales, the lead author of the study from Spain. I invited him to speak with us and I believe we were in California at the time at the American College of Nutrition. The day we spoke on the podium together was a day I started taking four tablespoons of olive oil a day.

I got to tell you, even in one of my businesses I actually manufacture olive oil from companies in California. I’m afraid of the European olive oils now because a lot of the olive oils in Europe are cut with canola oil, which is proinflammatory. The unfortunate thing is you can have a 75% extra virgin olive oil and 25% canola and the label will still say 100% extra virgin. That’s horrible. Canola oil is good for machines, it’s not good for humans.

Anyway, I’m a big believer in California extra virgin olive oil. By the way, Kara, the California Health Growers’ Council even certifies. On our olive oil bottles, for example, we have the certification from the California Growers’ Association because I believe olive oil is very medicinal for the body. It lowers blood pressure. It makes small particle LDL more fluffier. It raises HDL. It does everything right in the body. It’s absolutely amazing.

Dr. Kara Fitzgerald:You know, it’s funny because I was actually going to ask you about olive oil because we know that it’s compromised now, quality is compromised. I agree, my solution has been to go with California source at this point, unfortunately.

Dr. Stephen Sinatra:Well, make sure you send me your address and I’ll send you some nice flavored olive oil, garlic and rosemary. I have so much fun with olive oils and pasta sauces you wouldn’t believe.

Dr. Kara Fitzgerald:I can’t wait. I’ll send you my address every day for the next week.

Dr. Stephen Sinatra:Joanne’s going to send you … I’ll tell you this Kara, I’ve been involved with vitamins and minerals for more than three decades because I got into it early because of Jacob Rinse, right?

Dr. Kara Fitzgerald:Yes.

Dr. Stephen Sinatra:But the hardest thing in the country right now is eating healthy food. I’ve been working on healthy foods now for four or five years. The GMO problem is horrific. The BPA problem is horrific. The mercury and lead problem in the food … It goes on, and on, and on. We got to educate the public about healthy eating. It’s the most important thing you can do to your body and with all the insecticides, pesticides, and chemicals in the food supply you really got to be careful.

Dr. Kara Fitzgerald:Yes, yes. Let me ask you a couple questions that I had when I was reviewing the PREDIMED study before our conversation today. They had one arm swimming in olive oil, four tablespoons a day. They would give them a liter a week, I thought that was pretty interesting you’d go pick up your liter of olive oil every week. Then the other arm they were eating mixed nuts basically. What was interesting to me, this showed some pretty interesting turnaround. There was about a 30% reduction in both groups for cardiovascular deaths and then stroke was actually reduced more. It looks like it was 46% in the nut group, versus 33% in the olive oil group. I don’t know, it looks like it achieved statistical significance. Is that correct?

Dr. Stephen Sinatra:Oh, absolutely, yeah. In other words, what you’re trying to say is that the nut group and the olive oil group are very similar where the one had less stroke and the other had less heart attack or less death it doesn’t matter. Whether you did nuts or olive oil as opposed to the American Heart Association diet…

Dr. Kara Fitzgerald:Was that their control? Was the American Heart Association…

Dr. Stephen Sinatra:Yeah, that was the control, that was the control. Remember, the American Heart Association diet unfortunately there’s a lot of carbohydrate in it, they don’t like fat. I like fat because it helps the insulin situation. Basically, if you like a lot of healthy, organic nuts go for it. If you want a lot of healthy olive oil I tell my patients to go for it, just do it.

Dr. Kara Fitzgerald:Do you think that there would have been a difference if they had done the study having a study arm as nuts and olive oil?

Dr. Stephen Sinatra:Oh together?

Dr. Kara Fitzgerald:Yeah.

Dr. Stephen Sinatra:I asked Gonzalez that same question. He thought it would be beneficial, almost like if you took, for example, for the brain I use COQ10 and omega-3 for the brain, but when I learned about the synergism of turmeric and resveratrol that’s why I mix those because Alzheimer’s and memory disorders are astronomical in our country. A lot of it has to with the EMF, and insecticides and pesticides. We can get into that conversation later, but protecting the brain and the brain and the heart are the most sensitive mitochondrial cells in the body. Those two are the most specialized, but yet, the most sensitive to the environment.

Dr. Kara Fitzgerald:I hear you. So nuts and olive oil together, which of course many healthy eaters are consuming together, that would have an added bonus, as Gonzalez thought. Then if you throw in … I know they encouraged the consumption of seafood in the study, but if you actually threw in a controlled amount of omega-3s you’ve got that addition as well. They actually didn’t recommend that many vegetables, I think two servings or more a day. As we fine tune it in our practices, these numbers would just go up.

Dr. Stephen Sinatra:Correct, yes. It’s so easy, Kara. I just tell people to eat a lot of fresh fruits and vegetables, and if they want to eat organic meats then that’s okay with me. Again, it…

Dr. Kara Fitzgerald:Well listen…

Dr. Stephen Sinatra:I like a vegetarian diet about 80% of the time.

Dr. Kara Fitzgerald:Okay, that’s what I was going to ask you. There are studies that demonstrate significant reduction in coronary heart disease with a vegetarian diet and likewise with paleo diets. Now, they don’t look quite as robust as the data from PREDIMED study but still, any comments on that because those are relatively different? Well, vegetarian as compared to paleo.

Dr. Stephen Sinatra:Yes. This is how I would answer that. I think my psychotherapy training would lend some interesting favors here. The problem with a lot of people with dietary regimens, they become too rigid. In other words, it grew very strict whether it’s vegan, vegetarian. I’ve seen people who are so fanatical on this that they do lose with it.

For example, I had two women in my practice as a cardiologist, both had cardiomyopathy, both had breast cancer at the same time. Now think about that, Kara, having breast cancer and cardiomyopathy at the same time. They were both Asian women, both vegan women. When I tested their COQ10 levels they were in the basement. They were like .01, .02. this was from good labs out in the Midwest.

I have to tell you, when it comes to dieting, the worst thing you can do is just become so rigid where you cut out, stay on certain foods over and over again. That’s why I like vegetarianism, 80%. If you want to have some organic meats like buffalo, or free range chicken, or wild fish in the diet that’s okay with me. I like that. Even as a heart specialist, people come in who are so rigid on their diets. I try to coach them and have to use some psychotherapy sometimes and basically try to show them that being a little lenient on either meat or vegetables was far better.

However, when it comes to sugar and pure sugars in the diet like sodas, or white table sugar, or lots of breads or carbohydrates then I would be a little stricter with these people. A lot of vegans, for example, do a lot of sugary carbs and they get inflammatory disease and they even get coronary disease. It’s important for us to really look at diet, not from such a rigid point of view. That’s why I like to bring some meat to the table, so to speak, in sort of a vegetarian diet.

Dr. Kara Fitzgerald:Let’s talk about saturated fats. I know obviously not all saturated fats are created equal, there’s the short, medium, long, very long chain fats. Give me your thoughts on saturates overall and then maybe…

Dr. Stephen Sinatra:Overall in a diet I don’t worry about saturated fat like some of my colleagues do. Look, saturated fats don’t require insulin, which is a very important aspect. Now look, if you replace saturated fats with refined carbohydrates and you use carbohydrates because you think they’re safer than saturated fats your incidence of coronary artery disease increases, absolutely increases.

I look at it this way, if a person says to me, “Doc, I like to eat a diet that’s maybe 20% to 30% protein and maybe about 30-40% carbohydrate, and the rest fat, is that okay?” Absolutely. I endorse that. Now, if they say, “Look, I’m avoiding all trans fats. I’m getting rid of the inflammatory fats and I like a lot of omega-3s, but I’m avoided the saturated fats,” I don’t go for that because I think saturated fats are important for you. Like I said, I don’t think they do the harm that we think they did years ago. So as a heart specialist I allow my patients to go with saturated fat. Look, the PREDIMED study sort of supports it as well.

Dr. Kara Fitzgerald:You said you were debating in your publication with Houston and the idea of medium-chain triglycerides. What was the take home? What were you guys…

Dr. Stephen Sinatra:The take was this, the take was this: try to eat more mild unsaturated fats. But if you did want to have some degree of saturated fats like maybe a little coconut or something, if you wanted to do that we were okay with that. We let that go.

Dr. Kara Fitzgerald:Good.

Dr. Stephen Sinatra:In other words, I didn’t want to bring rigidity to the table. Look, it’s like chocolate, Kara, I know some people who would avoid all sweets, but when it comes to the dark polyphenols or the polyphenols in dark chocolate that’s like 80% there’s good data to show that dark chocolate, the polyphenol activity reduces high blood pressure, so to speak. The problem with a lot of us when it comes to diet our own rigidity gets in the way and we have to watch that.

Dr. Kara Fitzgerald:Speaking on that topic of rigidity, what about Esselstyn, his approach it’s a vegan fat-free. I know where you’re going with this or what your opinion is…

Dr. Stephen Sinatra:We have our battles. Listen to this, I revere him. I respect him. My gosh, he was a hero in Vietnam. I’ve got to tell you, he’s a prince of a guy. I just disagree with him on certain aspects of the diet. He’s a pure vegan.

Dr. Kara Fitzgerald:And no fat.

Dr. Stephen Sinatra:Even in the Ornish study years ago they had a plaque rupture. You need fats to stabilize plaque, there’s no doubt about it. I would say this, that if you did do a vegan diet, if you followed the Esselstyn diet most people would do okay, but there are some people that wouldn’t do okay. Now that we know about the BioGenome project I would say that you need some fats. We need fats. For people who restrict fats too much, if you don’t have the genetic hardware in your body, oh my gosh, well then you’re on a path to a possible cardiac event.

Dr. Kara Fitzgerald:Quite simply our brain is what, 70% fat?

Dr. Stephen Sinatra:Exactly, exactly. Again, the brain, the heart, and retina, they share a lot of nutritional considerations.

Dr. Kara Fitzgerald:Let me ask you about … We were chit-chatting on the phone before about the APOE alleles-

Dr. Stephen Sinatra:Right.

Dr. Kara Fitzgerald:The four, four, three, four, et cetera, two, two. What do you think about with regard to advising your patients with these particular with the…

Dr. Stephen Sinatra:Well, if you’re dealt a poor set of alleles, for example, if you’re dealt poor genetics, this is something that people can possibly interfere with, with diet. In other words, if you don’t have the genetic structure and if you’re your prone to memory disorders or Alzheimer’s disease then I would tell people to really beef up the omega-3, increase coenzyme Q10, increase carnitine, use acetyl-L carnitine, resveratrol, use turmeric. In other words, if you get a bad set of genes and you know … I always tell them to drink less alcohol, use less sugars. Sometimes these genetic maps can cause a lot of undo stress because we think we’re going to be doomed. On the other hand, it gives you a blueprint to work from so you can do something in the environment to protect yourself. You’re dealt a bad set of genes, it’s not a death sentence. Now you have the knowledge to combat it on the environmental level and then you can choose your diet and your supplements wisely.

Dr. Kara Fitzgerald:Actually more and more research is coming out demonstrating just that and specifically with the APO3/4 and turning around risk with diet.

All right, definitive word on alcohol, I thought it was kind of interesting that the PREDIMED study allowed seven or more glasses of wine a week.

Dr. Stephen Sinatra:It’s a lot.

Dr. Kara Fitzgerald:You could have quite a bit of alcohol. You could have quite a bit of alcohol and they still got these really amazing numbers. What’s your comment? There’s studies coming out all the time with differing conclusions with regard to it.

Dr. Stephen Sinatra:Well, they allowed seven drinks a week, right?

Dr. Kara Fitzgerald:Seven or more, greater than or equal to seven glasses a week.

Dr. Stephen Sinatra:Of wine.

Dr. Kara Fitzgerald:Of wine.

Dr. Stephen Sinatra:That’s like a glass a day. That would be my max. I always tell people when it comes to wine every other day is really the best. A glass or two of wine every other day, give your body a rest. Look, let’s face it, the French paradox demonstrates that the French have an average cholesterol of 260 to 270. They have the lowest incidents of heart disease in Western Europe. We think it’s the resveratrol in the red grape, or the wine, for example. They’re drinking a lot of red wine. This protects you from coronary artery disease. However, however, the French have the highest incidents of cirrhosis in the world. We have to look at these and say, okay, moderation is the key. It’s almost like going back to the vegetarian diets, these pure vegetarian diets. We cannot be rigid.

The same thing is true with alcohol. A little alcohol is okay, but too much alcohol definitely has a downside, definitely has a downside. I don’t want people drinking alcohol if they don’t drink alcohol. Even my patients come in and say, “Dr. Sinatra, should I start drinking wine?” I would say, “No, don’t do it.” Why drink if you don’t have to? But I would put them on supplements. I’d put them on resveratrol, and omega-3s, and things like that. If people want to drink wine that’s okay with me. Again, as long as they’re organic. A lot of wines have sulfites or too many sulfites, too many insecticides, pesticides. If you can do a nice organic wine with some nice phytonutrients in it, I’m all for it.

Dr. Kara Fitzgerald:All right, I have a few more questions for you. We’re way over time. Folks, I appreciate you hanging on. I know this has been a really interesting podcast.

Give me a rundown, I guess me being a lab geek with my laboratory background, give me a rundown on the labs that you’re thinking about that are the essential investigations you’re going to be making on your patients.

Dr. Stephen Sinatra:When I was practicing cardiology, I always looked at inflammation. I never believed in the cholesterol theory of heart disease, although small particle LDL and Lp(a) is really the truth about cholesterol. I write that it in my book “The Great Cholesterol Myth.” That’s all available. When it comes to this cholesterol theory, this whole LDL situation, we just have to be careful in a sense that we can’t focus on cholesterol too much because if you focus on the LDL in the body and primarily focus on that, some of these people may be eating far too many carbohydrates, for example. They may throw fats out of their diet. It’s like throwing a baby out with the bath water.

Kara, it’s just important to realize that I really feel when it comes to heart disease, inflammation is the key. What I go after I can look at inflammatory mediators in the blood like homocysteine, for example, Lp(a), I mentioned it before, it’s highly inflammatory. In fact, Lp(a) is like a small cholesterol particle with a disulfide bridge. Not only is it highly inflammatory, it causes blood clots. So…

Dr. Kara Fitzgerald:Yes, yes. Well…

Dr. Stephen Sinatra:… when I check people for Lp(a) I would want to reverse it. I would use lumbrokinase and nattokinase and things like that. Fibrinogen in postmenopausal women, horrible, horrible. The fibrinogen levels go up you got to reduce fibrinogen. If you have a let of serum ferritin in the body that’s a proinflammatory mediator as well.

I mentioned homocysteine, these inflammatory mediators, now high blood sugar is an inflammatory mediator. We need to look at the blood and then it’s myeloperoxidase and newer ones, I wrote about that with my son Drew in a recent article in the Alternative Therapies. But there are so many inflammatory mediators that you can go to your doctor, especially somebody like you who came out of the laboratory, you can measure these inflammatory mediators and neutralize them. When you do that you’re doing your patient a lot of good. It’s not just LDL and HDL, which a lot of patients think it is. There are more potent inflammatory mediators in our body that there’s functional HDL or small particle LDL.

Dr. Kara Fitzgerald:Yeah absolutely. Thanks for that pearl on how you lower Lp(a). I lean on niacin. I certainly have tried a lot Vitamin C ala Pauling. I just didn’t see the turnaround but Lumbrokinase…

Dr. Stephen Sinatra:Lumbrokinase is the best, Kara.

Dr. Kara Fitzgerald:How are you dosing it? How are you dosing it?

Dr. Stephen Sinatra:I basically tell people to take two capsules a day. I have no affiliation with the company. Its a Canadian company. It’s called Boluoke, B-O-L-U-O-K-E, I think you can get it online. I think they’ve done the best research on Lp(a).

Dr. Kara Fitzgerald:Perfect.

Dr. Stephen Sinatra:I just use it because Lp(a) is the real cholesterol story, like I mentioned before. That is the real story.

Dr. Kara Fitzgerald:You’re certainly one of the pioneers in our … You are, you’re just such a pioneer as you’ve shared your extraordinary experience and stories with me today, which I just really appreciate that we diverged because it was so inspiring to me.

A lot of new students studying medicine, there’s a whole lot of student naturopathic doctors to be listening and there are plenty of medical doctors transitioning into functional medicine who will tune into our podcasts. From your journey, what would you say to them about this amazing journey they’re embarking on? Any words?

Dr. Stephen Sinatra:Yes, yes. Your patients will be your best teachers, not your professors, which will give you the basics. Listen to your patients because the more alternative are the more your patients will flock to you. Some of these patients will come up with amazing discoveries that you never heard of, for example. They will come in and say, “Hey doc, I started taking licorice root and it’s amazing. It really helped me.” Or they will come in with this herb or that herb. You may not know anything about it. What I used to say to my patients over the years is, “Can you bring me an article on it,” or, “Tell me where you learned about it,” because when patients get better…

Remember this Kara, most good doctors become a good health coach. They do a dance with their patients. When you can get your patients on the right road, the road better traveled, so to speak, and try to educate them in diet and supplements and earthing and grounding and detoxification measures, whatever it is. These patients go out there and they read, and they bring you material, and they experiment on their own bodies, I’ll tell you, it’s like that one woman I put on a coenzyme Q10 with a postpartum cardiomyopathy. That’s one patient that opened up the door to 1000s and 1000s of patients. Patients are your best teachers, that’s what I would tell a naturopath, a medical MD, and just listen.

Unfortunately, a lot of doctors they’re such in a rush, and they’re taking notes, and they don’t listen to the patient’s story. I’ll tell you this, Kara, the most important patient story is the last 10 seconds in the room. Are you privy to that?

Dr. Kara Fitzgerald:Yeah, yes… the walking out the door.

Dr. Stephen Sinatra:Exactly. I call it the hand-on-the-doorknob syndrome when you’re walking out of the exam room, right?

Dr. Kara Fitzgerald:‘Oh by the way.’

Dr. Stephen Sinatra:Exactly Kara, you got it. “Oh doc, there’s one more thing.” Oh by the way, and guess what? That’s their death layer. That’s the last thing they want to give up. That is the truth of the patient. A good doctor will stop and listen to that last one more thing because that’s the truth that the patient wants to get across. It took me 10 years of psychotherapy to realize that.

Dr. Kara Fitzgerald:That’s beautiful. That’s a great way to end. Well Dr. Sinatra, thank you so much for joining me today on New Frontiers.

Dr. Stephen Sinatra:Oh, well thank you Kara. It was a great interview. Thanks so much.

Dr. Kara Fitzgerald:Absolutely.

And that wraps up another amazing conversation with a great mind in functional medicine. I am so glad that you could join me. None of this would be possible through the years without our generous, wonderful sponsors, including Integrative Therapeutics, Metagenics, and Biotics. These are companies I trust, and I use with my patients, every single day. Visit them at IntegativePro.com, BioticsResearch.com, and Metagenics.com. Please tell them that I sent you and thank them for making New Frontiers in Functional Medicine possible.

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The Sandy Hook Clinic (SHC) is located in the Sandy Hook Village section of Newtown, Connecticut in Fairfield County, Connecticut. The clinic is housed on the fourth floor of a rehabilitated old brick mill building, overlooking the Pootatuck River.